Alemania

a. O b se rv a tio n

Observation entails the systematic noting and recording of events, behaviors, and artifices (objects) in the social setting chosen for study. The observational record is frequently referred to as field notes—detailed, non-judgmental, concrete descriptions of what has been observed. For studies relying exclusively on observation, the researcher makes no special effort to have a particular role in the setting; to be tolerated as an unobtrusive observer is enough.

Observation can range from a highly structured, detailed notation of behavior structured by checklists to a more holistic description of events and behavior. In the early stages of qualitative inquiry, the researcher typically enters the setting with broad areas of interest but without predetermined categories or strict observational checklists. In this way, the researcher is able to discover the recurring patterns of behavior and relationships.

Observation is a fundamental and highly important method in all qualitative inquiry. It is used to discover complex interactions in natural social settings. Even in studies using in­ depth interviews, observation plays an important role as the researcher notes the interviewee’s body language and affect in addition to her words. Discomfort, uncomfortable ethical dilemmas and even danger, the difficulty of managing a relatively unobtrusive role, and the challenge of identifying the big picture while finely observing huge amounts of fast- moving and complex behavior are just a few of the challenges.

For the purposes of this study, observation was used throughout the data collection process. I started with observations because I wanted to gain preliminary knowledge and insight of the

research sites ahead of the other data collection methods such as the interviews and focus group discussion. Choosing to conduct observations before conducting interviews proved to be very insightful as this allowed me to structure the research questions appropriately based on the notes from the observations conducted. These observations were non-participant observations.

Observations were done in the hall ways of the healthcare facilities visited, recording the behaviors of healthcare providers and patients; while waiting for interviews and recording the communication and language usage patterns (written and non-written) in these settings. I also recorded the body language and gestures of the participants in the interview setting.

I used these observations to verify the responses that the informants had given about their patterns of language use. According to Kamwendo (2004: 18), doing a survey of the notices posted in the healthcare facilities is a useful source of data collection on language in the healthcare sector as this will give data on language usage over and above verbal communication. I therefore adopted the same technique by observing the language notices and other forms of non-verbal communication used in the facilities investigated. I made notes on notices posted on notice boards, health education posters and sign posts to be able to identify language and communication patterns.

All the observations were recorded in my research diary which I carried with me all the time. The research diary included the following details: reactions or comments, new ideas on how to proceed with the study, literature reviews and comments and/or insights from the literature, frustrations, new findings, daily reflections or reviews of work done, tentative interpretations, names and addresses of possible informants or other persons likely to assist in data provision. The diary enabled me to reflect on the data collection process. Information contained in the diary was also useful during the writing up of the thesis.

Observations were of significant value for this study as it allowed me to be able to get a sense of the research site and environment before conducting other forms of data collection. This also assisted in structuring the data collection methods more appropriately. In Cofimvaba for an example, while doing observations at the Cofimvaba Hospital, I observed that almost everyone at the facility spoke ‘deeper IsiXhosa’ and that I would not understand because even though I spoke IsiXhosa, but because I am from the Northern Cape, where IsiXhosa is diluted with Afrikaans and not widely spoken, I would have challenges during the in-depth

interviews phase of my data collection. As a consequence of this unanticipated issue which arose in the field I requested the assistance of someone who was from Queenstown - a town within the same municipal district.

There were some limitations on observations. It was practically impossible to observe all the sections of the healthcare facilities. In addition, some areas had restricted access. The restricted places included wards for patients who were under intensive care. Another limitation was that it was impossible to observe everything. Some sociolinguistic behavior and patterns may have gone unnoticed. Another problem was the observer bias (also known as the Hawthorne effect). This refers to the invalid observations that result from the fact that the subject knows that he or she is under observation. I minimized this problem by being as non-intrusive as possible.

b. In- depth Interviewing

Kahn and Cannell (1957:159 as quoted in Marshall 2006: 101) describe interviewing as “a conversation with a purpose”. Interviewing varies in terms of a priori structure and in the latitude the interviewee has in responding to questions. Patton (2002, 341-347) puts interviews into three general categories: the informal, conversational interview; the general interview guide approach; and the standardized, open-ended interview.

According to Marshall (2006: 101), qualitative, in-depth interviews typically are much more like conversations than formal events with predetermined response categories. The researcher explores a few general topics to help uncover the participant’s views but otherwise respects how the participant frames and structures the responses. This method, in fact, is based on an assumption fundamental to qualitative research: the participant’s perspective on the phenomenon of interest should unfold as the participant views it, not as the researcher views it (ibid).

The method of interviews was chosen because I wanted to gain insight into people's beliefs and perceptions of their experiences. Individual interviews are more useful for evoking personal experiences, opinions and group interviews for capturing interpersonal dynamics, and achieving consensus on cultural and language issues, in the context of this study. Structured standardized questionnaires were rejected as they presuppose too much of what the participant might say and do not allow participants to answer in their own terms, so semi­ structured, in depth interviews were used.

Combined with observation, interviews allow the researcher to understand the meanings that everyday activities hold for people, (Marshall 2006:102).

Interviewing has limitations and weaknesses, however because interviews involve personal interaction; cooperation is essential. Interviewees may be unwilling or may be uncomfortable sharing all that the interviewer hopes to explore, or they may be unaware of recurring patterns in their lives (ibid). The interviewer may not ask questions that evoke long narratives from participants because of a lack of expertise or familiarity with the local language or because of a lack of skill. By the same token, she may not properly comprehend responses to the questions or various elements of the conversation. And at times, interviewees may have good reason not to be truthful, (ibid). None of the above difficulties were experienced during the study.

In addition to generic in-depth interviewing, there are several more specialized forms, including ethnographic interviewing, phenomenological interviewing, elite interviewing, focus group interviewing, and interviewing children. These are described briefly.

c. Ethnographical interviewing

Based on cognitive anthropology, ethnographic interviewing elicits the cognitive structures guiding participants’ worldviews. Described as “a particular kind of speech event” (Spradley, 1979:18 as quoted in Marshall 2006: 104), ethnographic questions are used by the researcher to gather cultural data. Ethnographic interviewing is not simply doing an interview. Instead, it is an elaborate system of a series of interviews structured to elicit insiders’ cultural knowledge. Spradley identifies three main types of questions: descriptive, structural, and contrast. Descriptive questions allow the researcher to collect a sample of participants’ language. Structural questions discover the basic units in the participants’ cultural knowledge, and contrast questions provide the ethnographer with the meaning of various terms (as quoted in Marshall 2006:104).

The specialised type of interviewing which the study adopted could be described as ethnographical interviewing. The questions were descriptive, structural and contrasting. An example of descriptive questions used in the study during the interview process include questions such as - What languages can you speak - both for general communication and for

communicating medical instructions to your patients/ what language do you speak with your doctor?

Structural questions used in the study during the interview process included questions such as - Have you experienced any difficulties in, e.g. taking personal data, taking medical history,

problem in counselling, understanding cultural practices associated with illness, poor adherence to medical treatment?

Contrast questions used in the study during the interview process included questions such as -

Do you fin d that you don’t understand your doctor at times or you feel you think your doctor doesn’t understand you sometimes? I f so, do you feel better or not, and i f not? Can you please explain what happened?

This form of interviewing proved to have been the most suitable as the study took an ethnographic approach. Other specialised form of in-depth interviewing are briefly discussed below.

d. Phenomenological interviewing

Marshall describes phenomenological interviewing as a specific type of in-depth interviewing grounded in a philosophical tradition (2006:104). Phenomenology is the study of lived experiences and the ways we understand those experiences to develop a worldview. It rests on the assumption that there is a structure and essence to shared experiences that can be narrated. The purpose of this type of interviewing is to describe the meaning of a concept or phenomenon that several individuals share, (ibid). This form of interviewing was not adopted as it was not relevant to the study in assessing the role of language in accessing healthcare in rural and semi-rural areas.

e. Interviewing Elites

An interview with an “elite” person is a specialized case of interviewing that focuses on a particular type of interviewee (Marshall 2006:105). Elite individuals are considered to be influential, prominent, and/or well-informed in an organization or community; they are selected for interviews on the basis of their expertise in areas relevant to the research (ibid). For this study, the interviewing of healthcare providers in order to gain the insight of healthcare providers could be described as Elite Interviewing as the insights gained from doctors can only be gained from them as experts within the healthcare sector.

Elite interviewing has many advantages. Valuable information can be gained from these participants because of the positions they hold in social, political, financial, or administrative realms (Marshall 2006:105). Elites can provide an overall view of an organization or its relationship to other organizations, albeit from their own limited and bounded perspectives. They may be quite familiar with the legal and financial structures of the organization. Elites are also able to report on an organization’s policies, histories, and plans, again from a particular perspective (ibid).

Elite interviewing also presents disadvantages. It is often difficult to gain access to elites because they are usually busy people operating under demanding time constraints; they are also often difficult to contact initially (ibid). I experienced this during the study while trying to secure interviews with doctors as they had busy schedules and interviews often had to be rescheduled.

f. Interviewing Children

Children may be the primary focus of a study or one of many groups the researcher wants to interview. Increasingly, there are calls for including children’s perspectives as relevant and insightful in learning more about aspects of their worlds (Marshall 2006:206). This technique was not applicable as the study did not focus on any particular age group.